Supervision

Clinical Supervision.

All patients receiving neurosurgical care, outpatients, inpatients, and those seen in the Emergency Department, are under the direct supervision of an attending in neurosurgery.  Residents care for these patients and are engaged in the operating room as their abilities warrant.  However, during each operation and during the pre and post operative periods, there is constant attending input and supervision.  During interactive teaching conferences, morbidity and mortality conferences, and teaching rounds residents are challenged and feedback provided by attendings in neurosurgery, neurology, neuroradiology and neuropathology.  In the outpatient settings, attendings are available to see the patients and to supervise the evaluation and treatment plans.

Communication.

Neurosurgery attendings are and will continue to be notified immediately in the circumstances noted below.  These notifications may come from a resident, fellow, or P.A. at any level but occur at anytime, day or night.  Note the team including attendings, residents, P.A.s must all regularly communicate patients status and  plans to one another but these areas require urgent interaction with attendings.

  1. When any patient is being considered for admission or transfer to their service unless the attending in question has already arranged for the admission or transfer.  This notification may come from a resident, fellow, or PA at any level but occurs before the patient is actually admitted and at anytime, day or night.
  2. Similarly, all consults are to be rapidly seen and discussed with the attending including outpatients, inpatients and Emergency Department patients.
  3. Neurologic deterioration/change including unexpected seizures (i.e., unmonitored patients).  Includes wound problems and CSF leak.
  4. Invasive monitoring.
  5. Emergence or progression of systemic disorder.  Examples include concern for pulmonary embolism, myocardial ischemia, respiratory compromise, sepsis.
  6. Unexpected changes in vital signs requiring an intervention or diagnostic procedures not covered in the daily plan.
  7. The planning of diagnostic imaging.  In particular, urgent imaging needs to be immediately communicated
  8. Need for consultation by another service.
  9. Unexpected and significantly abnormal laboratory values.
  10. Narcotic administration in children and conscious sedation.
  11. Anticoagulation.
  12. Need for chemical or physical restraints
  13. Out of the ordinary or persistent patient complaints.
  14. Acute manpower issues.